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1993:  Early Development and Evaluation of the Oregon POLST Program

The original form, known as the Medical Treatment Coversheet (MTC), included a set of portable standard medical orders regarding life-sustaining treatments based on a patient’s preferences including those in their advance directive. The Task Force and OHSU’s Center for Ethics worked with Oregon legislators to strengthen the advance directive statute to help patients and families express their values about future life-sustaining treatment use including artificially administered feedings by tube. Rather than such treatments being routinely applied, patients now were better empowered to determine which treatments they wanted if they became seriously ill. The MTC reflected this empowerment, having medical orders for various life-sustaining treatments, including Section D about tube feedings.

Medical Treatment Coversheet (first version that later became the POLST form, click on form to enlarge).

Medical Treatment Coversheet (first version that later became the POLST form, click on form to enlarge).

The MTC was refined with focus group feedback from clinicians caring for patients in acute and long-term care settings. Prior to clinical use first responders were given clinical scenarios to assure orders would never result in under treatment (see annotation of Journal of the American Geriatrics Society, 1996;44, 785-791). The name was changed to “Physician Orders for Life-Sustaining Treatment (POLST)” to distinguish the medical order form more clearly from a traditional advance directive. The following organizations endorsed the MTC for voluntary use: 

  • Center for Ethics in Health Care, OHSU
  • Multnomah County Medical Society
  • Oregon Association of Homes for the Aging
  • Oregon Association of Hospitals
  • Oregon Chapter, American College of Emergency Physicians
  • Oregon Health Care Association
  • Oregon Health Decisions
  • Oregon Hospice Association
  • Oregon Long Term Care Nurses Association
  • Oregon Society of Physician Assistants
  • Oregon State Ambulance Association